Good news! We’ve made it easier for Texas Children’s Health Plan members to log in to the MyChart website. Now, you can access all your MyChart health care features anytime, anywhere using our new sign-in widget. Click the link to log in now
¡Buenas noticias! Hemos hecho más fácil el inicio de sesión en MyChart para nuestros miembros de Texas Children’s Health Plan. Ahora puedes acceder a todas las funciones de cuidado médico de MyChart en cualquier momento y desde cualquier lugar mediante nuestro nuevo widget de inicio de sesión. Haz clic en el enlace para iniciar sesión.
Important UpdateActualización importante:
Good news! All CHIP, STAR, and STAR Kids Member Handbooks are now available online. Quick, easy access to your benefits and coverage information - any time!
¡Buenas noticias! Todos los manuales para miembros de CHIP, STAR y STAR Kids ya están disponibles en línea. Obtén acceso rápido y sencillo a la información sobre tus beneficios y cobertura, ¡en cualquier momento!
Prior Authorization Criteria and Age Limitation Updates for CAD Enzyme Replacement Therapy
Date: October 6, 2026
Attention: Providers
Effective date: October 1, 2026
Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that effective for dates of service on or after October 1, 2026, prior authorization will be required for clinician-administered drugs (CADs) tividenofusp alfa-eknm (Avlayah) (procedure code J1757) and pegzilarginase-nbln (Loargys) (procedure code J1818). Texas Medicaid will also update the age limits for galsulfase (Naglazyme), imiglucerase (Cerezyme), and taliglucerase alfa (Elelyso).
The Texas Medicaid & Healthcare Partnership (TMHP) may approve prior authorization for tividenofusp alfa-eknm (Avlayah) (procedure code J1757) and pegzilarginase-nbln (Loargys) (procedure code J1818) if they are requested for the following indications:
Tividenofusp alfa-eknm (Avlayah) is indicated for the treatment of neurologic manifestations of Hunter syndrome (Mucopolysaccharidosis type II, MPS II) in presymptomatic or symptomatic pediatric clients weighing at least five kilograms before advanced neurologic impairment (diagnosis code E761).
Pegzilarginase-nbln (Loargys) is indicated to treat hyperargininemia in clients who are 2 years of age or older with arginase 1 deficiency (ARG1-D) in conjunction with dietary protein restriction (diagnosis code E7221).
Age Limitation Updates
Galsulfase (Naglazyme) is a hydrolytic lysosomal glycosaminoglycan (GAG)-specific enzyme indicated for clients who are 5 years of age or older with mucopolysaccharidosis VI (MPS VI; Maroteaux-Lamy syndrome) and may be reimbursed with diagnosis code E7629.
Imiglucerase (Cerezyme) is indicated for long-term enzyme replacement therapy (ERT) for adult and pediatric clients with a confirmed diagnosis of Type 1 Gaucher disease (diagnosis code E7522).
Taliglucerase alfa (Elelyso) is indicated for long-term ERT for adult and pediatric clients who are 4 years of age or older with Type 1 Gaucher disease (diagnosis code E7522).
Next step for Providers: Providers should share this communication with other prescribers.
